Illicit Drug Toxicity

Type of Drug Data

Data to October 31, 2021

Inclusion Criteria: This report is a companion report to the Illicit Drug Toxicity report
(http://www2.gov.bc.ca/gov/content/safety/public-safety/death-investigation/statistical-
reports) to summarize the drugs detected among suspected illicit drug toxicity deaths. [1] In
the majority of deaths, fentanyl or its analogues,[2] whether alone or in combination with
other drugs, was detected. Deaths were excluded if there were no illicit substances identified
or the death was suspected to be due to intentional self-harm. The detection of a drug does
not necessarily indicate that it contributed to death. The final cause of death and the role of
the drug will be determined by the coroner based on the full investigation.

This data has been compiled to better understand the types of drugs being detected in
recent illicit drug toxicity death in British Columbia and to inform other agencies’ public
safety strategies in a timely manner.[1] Note that fentanyl-detected data is subject to change as further
test results become available

Fentanyl Results:

• Preliminary data in 2021 has found that fentanyl or its analogues have been detected
in 84% of all illicit drug toxicity deaths. In 2020, fentanyl or its analogues have been
detected in 85% of deaths.
• Post-mortem toxicology results suggest that there has been a greater number of cases
with extreme fentanyl concentrations in Apr 2020-Oct 2021 compared with previous
months (concentrations exceeding >50ug/L (micrograms/litre).
o From Apr 2020-Oct 2021, approximately 14% of cases had extreme fentanyl
concentrations as compared to 8% from Jan 2019 to Mar 2020.
• Between Apr 2020-Oct 2021, 19% of fentanyl-detected illicit drug toxicity deaths in
Vancouver Coastal Health had extreme fentanyl concentrations (>50ug/L) followed by
14% in Fraser Health and 11% in Interior Health.
• Carfentanil has been detected in 152 suspected illicit drug toxicity deaths in 2021 and
66 in 2020.

Ministry of Public Safety and Solicitor General Posting Date December 9, 2021
Page 1 of 6
BC Coroners Service Fentanyl-Detected Suspected Illicit Drug Toxicity Deaths, 2012-2021

Figure 1: Percent of Illicit Drug Deaths with Fentanyl Detected

100%

80%

60%

40% 82% 86% 84% 85% 84%

67%

20%
25% 29%
15%
0% 4%
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

fentanyl detected no fentanyl detected

Figure 2: Percent of Fentanyl Detected Illicit Drug Toxicity Deaths with

Fentanyl Concentrations >50ug/L
30%
25%
25%
20% 20%
20%
16% 16% 15%
15% 15%
15% 14% 13% 13%
12%13%13% 12%
11% 11%
10% 9% 10% 10% 10% 10% 10%
10% 8% 8% 8% 8% 7% 7%
5% 4%
5% 3% 3%

0%
Jan
Feb

Jan
Mar
Apr
May

Sep

Nov

Jan
Feb
Aug

Mar
Apr
May

Sep
Aug

Nov

Feb
Mar
Apr
May

Sep
Aug
Jul

Oct

Jul

Oct

Jul

Oct
Jun

Dec

Jun

Dec

Jun

2019 2020 2021

*Data from most recent months are considered preliminary and are subject to change as more tests are
completed.

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BC Coroners Service Fentanyl-Detected Suspected Illicit Drug Toxicity Deaths, 2012-2021

Figure 3: Percent of Fentanyl Detected Illicit Drug Toxicity Deaths

with Fentanyl Concentrations >50ug/L by Health Authority
25%

19%
20%

14%
15%
11% 11%
10%
10% 8%
8%
6% 6%
6%
5%

0%
Interior Fraser Vancouver Coastal Island Northern

Jan 2019 - Mar 2020 Apr 2020 - Oct 2021

*Data from most recent months are considered preliminary and are subject to change as more tests are
completed.

Figure 4: Illict Drug Overdose Deaths with Carfentanil Detected

35 32
30
24
25 22
19 20 20
20 16 17 17
14 15 15
15 13
8 9 10 10
10 7 7 7 7 7 7 7
5 4
5 3 2 2 2 2
0 0 0
0
Aug
Jan
Feb

Aug

Jan

Jan
Mar

Sep

Feb

Feb

Aug
Sep
Apr
May

Nov

Mar

Sep
Apr
May

Nov

Mar
Apr
May
Oct

Oct
Jun
Jul

Jul

Oct
Dec

Jun
Jul

Dec

Jun

2019 2020 2021

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BC Coroners Service Fentanyl-Detected Suspected Illicit Drug Toxicity Deaths, 2012-2021

Other Drug Types - Expedited Toxicology Results:

As of July 1, 2020, the B.C. Coroners Service implemented a new expedited testing protocol that tests
21 drugs in a semi-quantitative manner and results are generated within a few days of samples being
received.[4] Samples from suspected drug toxicity deaths are sent for expedited testing and reported
presumptively prior to completing confirmatory testing.

• Results from the new expedited testing protocol have found that about 90% of submitted
samples have detected fentanyl and/or its analogues, 74% have detected at least one
stimulant, 20% have detected at least one other opioid, and 44% have detected at least one
benzodiazepine. Note that samples sent for expedited testing are a subset of all illicit drug
toxicity deaths (reported on page 1) where the initial investigation indicates a drug toxicity
related death.
• The detection rate of benzodiazepines has rapidly increased from 15% of samples in July 2020
to 53% of samples in October 2021. Reference: Etizolam Fact Sheet (BCCDC).
• From Jul 2020–Oct 2021, etizolam has been found in 41% of illicit drug toxicity deaths who
have undergone expedited testing.
• Among health authorities, Vancouver Coastal has the highest percentage of other opioids
detected (24%), and Fraser has the highest percentage of benzodiazepines detected (55%).
The percentage of fentanyl & analogues and stimulants detected was similar across all health
authorities.
• There is no indication that prescribed safe supply is contributing to illicit drug deaths.

Figure 5: Drug Types Detected in Expedited Toxicology Among Illicit

Drug Toxicity Deaths, Jul 2020 - Oct 2021
100% 95% 95% 93%
92% 90% 90% 92% 92% 91%
90% 89% 89% 87% 89%
86%
90% 83% 82%
78% 79% 79%
80% 73% 75% 74% 74% 73%
70% 70% 71% 71% 71%
68%
70% 78%
58% 57% 59%
60% 51% 53%
50% 49% 48% 50%
46% 48%
50%
36% 37%
40%

30% 26%
18% 17%
20% 27% 24% 24%
21% 21% 20% 20% 21%
10% 16% 16% 17% 17% 16%
15% 14% 13%
0%
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
2020 2021

Fentanyl & analogues Stimulants Other opioids Benzodiazepines

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BC Coroners Service Fentanyl-Detected Suspected Illicit Drug Toxicity Deaths, 2012-2021

Figure 6: Drug Types Detected in Expedited Toxicology Among Illicit

Drug Toxicity Deaths by Health Authority, Jul 2020 - Oct 2021
100%
90% 91% 90% 90%
90% 87%
81%
80% 74% 75%
71% 70%
70%
60% 55%
50% 43% 40% 39%
40% 34%
30% 24%
19% 19%
20% 16% 15%

10%
0%
Fentanyl & analogues Stimulants Other opioids Benzodiazepines

Interior Fraser Vancouver Coastal Island Northern

Figure 7: Substances Detected in Expedited Toxicology Among Illicit

Drug Toxicity Deaths, Jul 2020 - Oct 2021
100%
88%
90%
80%
70%
60%
48%
50%
41% 39%
40%
30%
20% 12%
8% 8% 7% 6%
10% 5% 2% 2%
0%

Notes: presence of acetylfentanyl is mostly likely due to an impurity of illicit fentanyl; concentrations of this drug are low and are unlikely to contribute
to toxicity. The presence of morphine indicates prior administration of morphine itself or can arise as a metabolite of codeine or heroin. The number of
cases where the decedent actually used morphine is likely much lower.

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BC Coroners Service Fentanyl-Detected Suspected Illicit Drug Toxicity Deaths, 2012-2021

Notes:
1. The BCCS operates in a live database environment. Some data for more recent years are based
on preliminary circumstances and are subject to change as investigations are concluded. Data
are not directly comparable to published counts from previous years.

2. Toxicology testing includes acetylfentanyl as of November 2015. Standard testing for

carfentanil, 3-methylfentanyl, furanylfentanyl, and W-18 began in June 1, 2017. Fentanyl-
detected data is derived from testing conducted by the BC Coroners Service.

3. More information about the health regions can be found at

http://www2.gov.bc.ca/gov/content/data/geographic-data-services/land-use/administrative-
boundaries/health-boundaries

4. Tests expanded to include screening for the following substances:

Fentanyl & analogues

acetylfentanyl
carfentanil
norfentanyl
Stimulants
Cocaine (inc. cocaethylene, benzoylecgonine)
Methamphetamine/amphetamine
MDMA/MDA
Other Opioids
6-Monoacetylmorphine
Codeine
Hydromorphone
Methadone (inc. EDDP)
Morphine
Oxycodone
Benzodiazepines & analogues
Alprazolam
Etizolam
Flualprazolam

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